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Chronic obstructive pulmonary disease (COPD) is a disease where both lungs are damaged and the airways become irreversibly narrowed. It is also known as chronic obstructive airway disease (COAD) or chronic obstructive lung disease (COLD). Patients present with breathlessness on exertion that progresses over time. In the end, breathlessness may occur even at rest.
The most important cause of COPD is cigarette smoking. Chemicals in tobacco damage the lungs with chronic smoking. Other less common causes include alpha1 anti-trypsin deficiency which is inherited.
Vaccination against pneumococcus (common cause of pneumonia) and influenza (yearly) is advised.
COPD cannot be cured. The damage to the lungs is irreversible. However, symptoms may be controlled with medication and smoking cessation. In fact, the most important measure is to stop smoking completely. Smoking cessation slows disease progression and improves survival.
The common medications for COPD are bronchodilators and inhaled steroids. These medications come in the form of inhalers and they play a role in relieving symptoms and preventing hospitalization. They do not reverse the lung damage done.
The severe breathlessness that COPD patients have often leaves them physically deconditioned. Rehabilitation involves more than exercise training. Patient education, proper inhaler/medication use, dietary advice and psychological counseling are the other components.
For patients who have severe COPD, blood oxygen level may be persistently low. This may result in worsening breathlessness and heart failure. These patients will benefit from using oxygen for at least 15 hours a day. Oxygen therapy at home can be provided either by an oxygen concentrator or oxygen tanks. The disadvantage of using oxygen tanks is that they are cumbersome and require regular refill. Patients will have their oxygen requirements determined in hospital before they are prescribed home oxygen therapy.
Lung volume reduction surgery (LVRS) is a new form of treatment for a subset of COPD patients. This surgery involves removing small parts of the lung which are diseased. By doing so, normal areas of the lung which are compressed by these diseased areas are now able to expand more normally. This is associated with an improvement of symptoms. Patients with emphysema may be suitable for this form of treatment. They are usually require to undergo pulmonary rehabilitation to maximize their effort tolerance before going for LVRS.
Lung transplantation is considered in the most severe cases.
